Healthcare Provider Details

I. General information

NPI: 1770163164
Provider Name (Legal Business Name): FREE YOUR MIND COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 04/10/2021
Certification Date: 04/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22791 JUNEBERRY CT
ELKHART IN
46514-9152
US

IV. Provider business mailing address

22791 JUNEBERRY CT
ELKHART IN
46514-9152
US

V. Phone/Fax

Practice location:
  • Phone: 574-400-5158
  • Fax: 574-701-2700
Mailing address:
  • Phone: 574-400-5158
  • Fax: 574-701-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA PATRICIA GARCIA
Title or Position: OWNER, PRESIDENT, CEO
Credential: LMHC, NCC, M.ED.
Phone: 574-400-5158